Expert: Dr. Sharon A. Mitchell - 5/5/2009

Question
My son is 2 years and 10 months and is diagonised with mild ASD. He is not hyperactive and he is undergoing speech therapy along with OT for the past 1 year. One of the problem which we face is his screaming on top of his voice when he does not get what he want, whether it is in shop or anywhere. We are not able to control him as he does not listen to us. How to control his screaming or any way to handle in these type of situations where we are at loss as to what we should do. Shouting or even mild hitting does not have any effect and we dont also want to do it. Tell us a solution.

Answer
I know what you're going through. It's rough isn't it, especially when you're out in public or it's been a long day.

To begin with, you're doing many things right. You've got a diagnosis at a young age so you know what you're dealing with. And your son is seeing both a speech therapist and an OT. This is ideal. Both these people should be of some help to you with your child's screaming.

While there are many reasons kids scream and tantrum, such as fatigue, wanting their own way, frustration, etc. there are two broad categories of reasons you could consider:

- communication
- sensory

All behavior can be regarded as communication. Kids who have delayed speech have an especially difficult time making their wants and needs known. Screaming, aggression and other forms of acting out can be their way of trying to communicate. Often speech therapists, while working on the goal of good oral speech, will try some other methods to help the child communicate while speech is still developing. Pictures are a common way. A good website to learn about this is at www.do2learn.com. Visuals (pictures) are a great way for you to let your child know what you expect of him and for him to let you know what he wants. Talk to your speech therapist about this.

Going along with visuals are social stories. These are brief explanations of what is going to happen. It sounds simple, but using them is a surprisingly effective strategy that can decrease negative behaviors. For instance, a social story about going for a walk might help. Carol Gray, who started the term social stories, has written a number of books such as this:

http://www.amazon.com/dp/188547766X?tag=autismhelpf0e-20&camp=14573&creative=327...

You can find examples of social stories at sites like :

http://www.polyxo.com/socialstories/

http://www.frsd.k12.nj.us/autistic/Social%20Stories/1social_stories.htm

http://www.adders.org/socialstories.htm

http://www.autismnetwork.org/modules/social/sstory/index.html


Here's a book I really like that offers help with behavior and communication

- Visual Strategies for Improving Communication : Practical Supports for School & Home by Linda Hodgdons http://www.amazon.com/dp/0961678615?tag=autismhelpf0e-20&camp=14573&creative=327...

Do you have any idea what sets off the screaming? Is there a pattern?

You could try charting when these negative actions occur. Divide a piece of paper lengthwise into three columns. Label the columns A, B and C. A stands for antecedent or what happened before you noticed the negative behavior. B stands for behavior and is where you'd describe what you are observing when your boy displays the behavior you don't want. C stands for consequence. What type of consequence did you impose after the behavior and how effective was your consequence. If you keep track for a few days or a week, you may begin to detect a pattern of when your son acts out. And how successful your consequences are at deterring these behaviors.

In kids with autism spectrum disorders sensory issues may be behind the negative behaviors. It's not uncommon for kids with autism to have sensory systems that are either under- or over-aroused.

I found that the lighting in some stores really set my son off. Avoiding that particular store made shopping far easier on all of us. When in a situation that may cause sensory overload (and tantrums), some kids respond well to weights. Weights can have a calming effect. You could consider a weighted vest, heavy blanket, having the child carry something heavy for you, etc. I know of a mom who grocery shopped with her child in the shopping cart, buried under groceries. It sounds bizarre but the feeling of weight and pressure kept her daughter calm. Talk to your OT about whether pressure vests or weighted vests might help your son.

At these sites, I've talked about some of the types of sensory issues that may be affecting your child:

http://www.autismsite.ca/html/hands_in_pants.html

http://www.autismsite.ca/html/wiggles_in_desk.html

http://www.autismsite.ca/html/gym_and_music.html

http://www.autismsite.ca/html/hits_others.html

http://www.autismsite.ca/html/frustrated.html

There are a couple little books by Brenda Smith Myles that I'd recommend. Ignore the word "Asperger's" in the title as what she says applies to all kids on the autism spectrum.

Asperger's Syndrome and Sensory Issues: Practical Solutions for Making Sense of the World (http://www.amazon.com/Aspergers-Syndrome-Sensory-Issues-Practical/dp/0967251486/...)

Asperger Syndrome And Difficult Moments: Practical Solutions For Tantrums, Rage And Meltdowns (http://www.amazon.com/Asperger-Syndrome-Difficult-Moments-Practical/dp/193128270...)

Thomas Phelan has written an easy-to-follow book called 1-2-3 Magic: Effective Discipline for Children 2-12. It shows you a calm, planned, not-reactive way to help your child learn cause and effect as he learns to control his behavior. I like it because the rules are clear-cut, taking the guess work and emotionality out of the situations. When you're dealing with a difficult child, anything that helps you remain calm is a boon. You can find this book here: http://www.amazon.com/1-2-3-Magic-Effective-Discipline-Children/dp/1889140163/re...

Kids with autism have difficulty making sense of their world. Adults with autism, such as Temple Grandin (http://www.amazon.com/Thinking-Pictures-Expanded-Life-Autism/dp/0307275655/ref=p...) and Donna Williams (http://www.amazon.com/Somebody-Somewhere-Donna-Williams/dp/1853027197/ref=pd_bbs...) talk about how this feels and how it affects the way they cope with their lives. These are intelligent, articulate women who have thought about and learned about what works for them. A two year old boy would not have the knowledge or experience to figure out such strategies on his own. As a parents, you can learn a lot of listening to and reading what successful adults with autism spectrum disorders have to say.

If you have trouble making connections and therefore making sense of your world, think how you would react. When you felt you had a handle on something, you'd resent anyone trying to change you or make you stop what was giving you comfort or pleasure. But in our lives, we don't get to do just what we want, even when you're two or three. So, when your son is enjoying his play, and you ask him to come to the table for dinner or get ready for bed, there may be an explosion. You've interrupted him. Many toddlers find this annoying but most learn to go along with what is asked of them (at least much of the time).

The child with autism may have even greater difficulties with such interruptions. You're asking him to end his play but on top of this, he may not know what you're asking of him or what will happen next.

Most kids fall into the pattern of the household and grow to anticipate what comes next and the order in which the family does things. But kids with autism may well not make such connections and even though you follow the same routine with him each evening, he still may not have picked up on the sequence of steps you always go through in getting him ready for bed.

Conversely, he may have internalized some of those patterns and woe is you if you deviate from the regular pattern. That's where social stories come in handy.

If from your charting, you find that these types of situations are causing your son trouble, there are several things you can try.

Before I describe some of these ideas, I'll give a bit of background information. It's common among people with autism to have strong visual skills and weaker auditory processing. That means that such people find it easier to take in information that they see rather than what they hear.

We talk to our kids a lot. That's a good thing most of the time. But when upset, a person with weak auditory processing skills will experience a further reduction in his ability to understand what is said to him. Unfortunately, as parents and as teachers, when we're frustrated we tend to talk even more to kids and maybe even with a raised or frustrated voice. This in turn, can upset the child more, and further hinder his ability to understand our words.

So, rather than talking in such situations, be quiet. Speak less. Speak calmly and most important, use pictures. Show the child what you mean. Visuals can be actual objects, photographs, line drawings or even hastily drawn stick figures. There are great software programs available to help you make visuals such as Boardmaker by Mayer-Johnson. Many Speech/Language Pathologists and schools will have this program. But at home there are some free visuals you can use available at sites such as www.do2learn.com. The do2learn site also has a good explanation on why visuals are something you really should try and how to get started.

Think back again to the difficulty many kids with autism have making sense of their world. If you were in a similar situation, I'd imagine that you'd be please to have a map and itinerary to let you know what was coming next.

Kids with autism disorders often respond amazingly well to schedules. You can post one on the fridge each day that will let your son know what will be happening that day. Again, pictures are available free on www.do2learn and the site also gives you suggestions on how to make your schedule.

Sometimes we nag kids. This is especially bad if a child has trouble understand what you're saying to him. Remember those Charlie Brown cartoons where the teacher's voice drones, "Waaa wa wa wa wa"? If you find yourself nagging your son to get ready in the morning, try putting a chart in his room that tells him how to get dressed. The first thing on the chart could be his underclothes, then his socks next, then a picture of his pants, etc. Or pull out your social story. Or your pictures of where you're going and what is expected of him.

Using pictures sounds so simple that some people think they can't possibly make a difference. They can. It's one of the simplest strategies I know of. At places like www.do2learn.com, the pictures are free so what do you have to lose by trying?

Best of luck,

Sharon A. Mitchell, B.A., B.Ed., M.A., Ph.D. candidate
www.autismstie.ca